A long-term prognostic value of CT angiography and exercise ECG in patients with suspected CAD

Gianluca Pontone, Daniele Andreini, Antonio L. Bartorelli, Erika Bertella, Sarah Cortinovis, Saima Mushtaq, Claudia Foti, Andrea Annoni, Alberto Formenti, Andrea Baggiano, Edoardo Conte, Francesca Bovis, Fabrizio Veglia, Giovanni Ballerini, Cesare Fiorentini, Piergiuseppe Agostoni, Mauro Pepi

Research output: Contribution to journalArticlepeer-review


Objectives The aim of the study was to perform a comparison of the prognostic performance of computed tomography coronary angiography (CTA) and exercise electrocardiography (ex-ECG) in patients with suspected coronary artery disease (CAD). Background CAD is a major cause of mortality and morbidity, and its management consumes a large proportion of the health care budget. Therefore, identification of patients at high risk of adverse events is crucial. Despite its limited accuracy, ex-ECG is the most commonly used noninvasive test in CAD evaluation. CTA was recently introduced as alternative test. Methods We enrolled 681 patients (age 61.3 ± 10.4 years, 461 men) with atypical or typical angina and no history of CAD. All patients underwent ex-ECG and CTA and were followed for 44 ±12 months. The endpoints were all cardiac events, defined as nonfatal myocardial infarction, cardiac death, and revascularization, and hard cardiac events, defined as all cardiac events excluding revascularization. Results ex-ECG and CTA were rated as positive in 419 (61%) and 274 (40%) of 681 patients, respectively. In univariate analysis, both ex-ECG and CTA were predictors of all cardiac events (hazard ratio [HR]: 2.09, 95% confidence interval [CI]: 1.5 to 2.8; p <0.0001 and HR: 21.1, 95% CI: 14.6 to 30.5; p <0.0001, respectively) and hard cardiac events (HR: 1.9, 95% CI: 1.1 to 3.2; p = 0.02 and HR: 6.8, 95% CI: 3.9 to 11.0; p <0.0001, respectively), whereas in a multivariate analysis, CAD with ≥50% stenoses detected by CTA was the only independent predictor of hard cardiac events. Stratifying our population by ex-ECG and CTA findings, Kaplan-Meier curves showed that ex-ECG provides only a further risk stratification in the subset of patients with positive findings on CTA and a low to intermediate likelihood of CAD. Moreover, positive findings on CTA identify a shorter event-free period, regardless the ex-ECG findings for both all cardiac events and hard cardiac events, respectively. Conclusions CTA may have a higher prognostic value compared with ex-ECG in patients with suspected CAD, mainly in those with a low to intermediate pre-test likelihood of CAD.

Original languageEnglish
Pages (from-to)641-650
Number of pages10
JournalJACC: Cardiovascular Imaging
Issue number6
Publication statusPublished - Jun 2013


  • computed tomography
  • coronary artery disease
  • electrocardiography
  • exercise
  • prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging


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